Moharari Reza Shariat, Shahinpour Shervin, Etezadi Farhad, Najafi Atabak, Khajavi Mohammad Reza, Pourfakhr Pejman
Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran.
Rom J Anaesth Intensive Care. 2022 Sep 25;28(1):1-9. doi: 10.2478/rjaic-2021-0001. eCollection 2021 Jul.
Goal-directed fluid therapy (GDFT) is a new concept to describe the cardiac output (CO) and stroke volume variation to guide intravenous fluid administration during surgery. LiDCOrapid (LiDCO, Cardiac Sensor System, UK Company Regd 2736561, VAT Regd 672475708) is a minimally invasive monitor that estimates the responsiveness of CO versus fluid infusion. We intend to find whether GDFT using the LiDCOrapid system can decrease the volume of intraoperative fluid therapy and facilitate recovery in patients undergoing posterior fusion spine surgeries in comparison to regular fluid therapy.
This study is a randomised clinical trial, and the design was parallel. Inclusion criteria for participants in this study were patients with comorbidities such as diabetes mellitus, hypertension, and ischemic heart disease undergoing spine surgery; exclusion criteria were patients with irregular heart rhythm or severe valvular heart disease. Forty patients with a previous history of medical comorbidities undergoing spine surgery were randomly and evenly assigned to receive either LiDCOrapid guided fluid therapy or regular fluid therapy. The volume of infused fluid was the primary outcome. The amount of bleeding, number of patients who needed packed red blood cell transfusion, base deficit, urine output, days of hospital length of stay and intensive care unit (ICU) admission, and time needed to start eating solids were monitored as secondary outcomes.
The volume of infused crystalloid and urinary output in the LiDCO group was significantly lower than that of the control group (p = .001). Base deficit at the end of surgery was significantly better in the LiDCO group (p < .001). The duration of hospital length of stay in the LiDCO group was significantly shorter (p = .027), but the duration of ICU admission was not significantly different between the two groups.
Goal-directed fluid therapy using the LiDCOrapid system reduced the volume of intraoperative fluid therapy.
目标导向液体治疗（GDFT）是一个描述心输出量（CO）和每搏量变异以指导手术期间静脉输液的新概念。LiDCOrapid（LiDCO，心脏传感器系统，英国公司注册号2736561，增值税注册号672475708）是一种微创监测仪，可评估CO对液体输注的反应性。我们旨在探究与常规液体治疗相比，使用LiDCOrapid系统的目标导向液体治疗是否能减少脊柱后路融合手术患者术中液体治疗量并促进其恢复。
本研究为随机临床试验，设计为平行对照。本研究参与者的纳入标准为患有糖尿病、高血压和缺血性心脏病等合并症且正在接受脊柱手术的患者；排除标准为心律不齐或严重瓣膜性心脏病患者。40例有内科合并症病史且正在接受脊柱手术的患者被随机且平均分配接受LiDCOrapid引导的液体治疗或常规液体治疗。输液量为主要结局指标。监测出血量、需要输注浓缩红细胞的患者数量、碱缺失、尿量、住院天数和重症监护病房（ICU）入住情况以及开始进食固体食物所需时间作为次要结局指标。
LiDCO组的晶体液输注量和尿量显著低于对照组（p = 0.001）。LiDCO组手术结束时的碱缺失情况明显更好（p < 0.001）。LiDCO组的住院天数显著缩短（p = 0.027），但两组间ICU入住时间无显著差异。
使用LiDCOrapid系统的目标导向液体治疗减少了术中液体治疗量。
